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Am J Psychiatry 1995; 152:64-71
Copyright © 1995 by American Psychiatric Association
Anorexia nervosa and anorexic-like syndromes in a population-based female twin sample
EE Walters and KS Kendler
Department of Psychiatry, Medical College of Virginia/Virginia Commonwealth University, Richmond.
OBJECTIVE: The authors explored the epidemiologic characteristics and risk
factors of anorexia nervosa and examined the relationship between narrowly
defined anorexia nervosa and anorexia-like syndromes. METHOD: Structured
interviews were administered to a population-based sample of 2,163 female
twins. Anorexia nervosa was diagnosed by computer algorithm ("computer
narrow") and by narrow and broad clinical definitions. RESULTS: Lifetime
prevalence estimates of 0.51%, 1.62%, and 3.70% were obtained for the
computer narrow, clinical narrow, and clinical broad diagnoses,
respectively. Dieting status, greater number of years of parental
education, low self-esteem, high levels of neuroticism, and maternal
overprotectiveness were significantly associated with anorexia nervosa.
Both the pattern of comorbidity and the relationship to epidemiologic risk
factors suggested an etiologic continuity between narrowly and broadly
defined anorexic syndromes. Co- twins of twins with anorexia nervosa were
at significantly higher risk for lifetime anorexia nervosa, bulimia
nervosa, major depression, and current low body mass index. Significant
comorbidity was found between anorexia nervosa and major depression,
bulimia nervosa, generalized anxiety disorder, alcoholism, phobias, and
panic disorder. CONCLUSIONS: The authors' analyses support the hypothesis
of a spectrum of anorexic- like syndromes in women. These syndromes are
familial and share familial etiologic factors with major depression and
bulimia nervosa.
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